Companies & business
Payment claim template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
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Preview — US standard
Final Demand for Payment
Business Name
Business Address
Business Phone or Email
Date: Letter Date
Sent by: Delivery Method and Tracking Number
To: Debtor Name
Debtor Address
Re: Unpaid balance of $Total Amount Owed
Dear Debtor Contact Name:
Our records show that you owe Business Name the following for Goods or Services Provided under Agreement, Purchase Order or Invoice References:
| Invoice | Date | Due Date | Amount |
| --- | --- | --- | --- |
| First Invoice Number | First Invoice Date | First Due Date | $First Invoice Amount |
| Second Invoice Number | Second Invoice Date | Second Due Date | $Second Invoice Amount |
Interest or late charges under our agreement: $Interest or Late Charges
Total owed: $Total Amount Owed
We sent reminders on Earlier Reminder Dates, but have not received payment.
Please pay the full amount by Payment Deadline by Payment Instructions. If you dispute any part of this amount, please tell us in writing before that date, with the reason, so we can review it.
If we do not receive payment or a written response by that date, we may take further action to collect, which may include Next Steps, such as referral to a collection agency, filing in small claims court or a lawsuit, and may seek interest, costs and attorney's fees where the agreement or the law allows.
This letter is sent by a business to collect its own business debt. It does not waive any of our rights.
Sincerely,
Sender Signature
Sender Name
Sender Title